Provider Demographics
NPI:1881443562
Name:OMESIETE, OBY (RN)
Entity type:Individual
Prefix:MRS
First Name:OBY
Middle Name:
Last Name:OMESIETE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2336 WISTERIA DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6162
Mailing Address - Country:US
Mailing Address - Phone:770-864-9398
Mailing Address - Fax:678-252-2179
Practice Address - Street 1:2336 WISTERIA DR STE 120
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6162
Practice Address - Country:US
Practice Address - Phone:770-864-9398
Practice Address - Fax:678-252-2179
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN176089163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1235459090Medicaid